High Court: Doctor’s lack of basic knowledge should have been clear if interview process was ‘worth its salt’

A doctor who worked as a senior house officer (SHO) in obstetrics and gynaecology at University Maternity Hospital Limerick (UMHL) has been suspended from the Register of Medical Practitioners due to a lack of basic medical knowledge and competence.

Within days of taking up a position in obs and gynae, staff at UMHL made complaints about the doctor’s lack of basic medical knowledge – including the fact that “he was never taught how to examine a pregnant woman”.

Stating that it was in the public interest to deliver the judgment in open court, Mr Justice Peter Kelly, President of the High Court, noted that this was not an isolated incident in the State and said that “if the interview process was worth its salt, it would have demonstrated his lack of basic medical knowledge”.

Background

On 9 July 2018, the respondent, FCM, was appointed as SHO in obs and gynae at UHML. He was registered in the general division of the Register of Medical Practitioners, maintained by the Medical Council, in October 2017.

In 2015, FCM, a Nigerian citizen, graduated in medicine from a Romanian university – however he was never registered to practice medicine in Nigeria or Romania. His CV stated that he had been a SHO in the Royal Infirmary Hospital in Edinburgh from October 2016 to February 2017; however, FCM was never registered to practice medicine in the UK. It transpired from a letter dated October 2016 that FCM was “merely an observer in the Department of Respiratory Medicine” and that he was “to have no hands-on contact with patients”.

FCM said that when he was interviewed for the job in UMHL, he told the panel that he “observed as an SHO” in Edinburgh, and that, when questioned about his clinical and medical diagnostic skills, he was forthcoming with the panel that he lacked experience, but with guidance he would be able and willing to learn if given the opportunity.

Concerns about basic competence

The Court heard evidence that “within days of taking up his appointment” in UMHL, issues arose regarding his competence and experience. Several complaints regarding his competence were made and on 20 July 2018, 11 days after taking up his position as SHO, FCM was told by the Clinical Director for maternal health that he was “to work only under supervision” as UMHL was “not a suitable place for any doctor without basic competencies”.

In August 2018, following an interview to assess FCM’s medical knowledge, two consultants made complaints to the Medical Council – both letters stating that there were serious concerns about FCM’s competence in basic medical tasks, that the assessment highlighted his lack of knowledge, and that FCM said he had never been taught how to examine a pregnant woman.

Following these complaints, a meeting of the Medical Council took place on 21 August 2018. At this meeting, FCM said that the interview in which he was assessed caught him off guard, and that he “blanked in an overwhelming situation”. Mr Justice Kelly said that this did not “explain the many shortcomings observed by medical and nursing colleagues from the time he began work”.

Publication of judgment necessary in the public interest

In the High Court, the Medical Council sought an order pursuant to s.60 of the Medical Practitioners Act 2007 suspending the registration of FCM and prohibiting him from engaging in the practice of medicine until further order. The Council stated that the application was ‘necessary in order to protect the public’ given the ‘significant risk’ if he were to continue to practice.

The application was heard in camera, however, Mr Justice Kelly said it was ‘in the public interest to deliver judgment in open court’ but without FCM being identified by name.

Recruitment procedures ‘defective’

Considering a marking sheet from FCM’s recruitment interview, Mr Justice Kelly said that “the marks and comments in the interview process which led to them must give rise to serious questions”.

Of particular note, was the conclusion that FCM was “short on experience” when he had “none at all”. FCM received a mark of 55/100 in respect of clinical medical and diagnostic skills – which Mr Justice Kelly questioned having regard to the fact that his “lack of those very skills was so obvious within days of his coming to work in the hospital”. Furthermore, the interview panel described FCM as “eager to work and learn” – but at whose expense? Mr Justice Kelly said that this surely “should not be at the expense of unwitting patients”.

Mr Justice Kelly said that if the interview process “was worth its salt, it would have demonstrated his lack of basic medical knowledge”. Stating that this was not an isolated incident, as he had encountered other cases involving the recruitment of registered medical practitioners with little knowledge of basic medicine, Mr Justice Kelly described the interview and recruitment procedures as “defective”.

Directing that FCM’s registration be suspended until steps are taken under Part 7, and if applicable, Parts 8 and 9 of the Medical Practitioners Act 2007, Mr Justice Kelly continued the prohibition on FCM from engaging in the practice of medicine until further steps are taken.

Mr Justice Kelly also directed that the judgment be sent to the Minister for Health, and the acting Chief Executive of the Health Service Executive.